脈絡膜剝離を伴った眼窩蜂窩織炎の1例

A case of orbital cellulitis with choroidal detachment

要約　目的：脈絡膜剝離を伴った眼窩蜂窩織炎の症例を報告する。

症例：74歳女性。左眼瞼腫脹・疼痛が出現し，2日後に高槻病院眼科を受診。眼窩蜂窩織炎と診断され，入院にて抗菌薬点滴加療が施行された。第8病日には眼瞼腫脹は軽快したが，眼底検査で左眼に網膜中心静脈閉塞症様所見と鼻下側に脈絡膜剝離を認め，光干渉断層計では脈絡膜皺襞を認めた。第19病日には脈絡膜剝離は消失していたが，脈絡膜皺襞は発症後約4か月の時点でも残存している。

結論：眼窩蜂窩織炎は眼窩内圧上昇や渦静脈の強膜貫通部位への炎症の波及により脈絡膜循環障害をきたし，本症例のように脈絡膜剝離を生じる可能性がある。

Abstract　Purpose: To report a case of orbital cellulitis with choroidal detachment.

Case: A 74-year-old woman presented with swelling and pain in the left eyelid. She had been diagnosed with diabetic retinopathy 2 years before.

Findings and Clinical Course: Corrected visual acuity was 1.5 right and 0.3 left. The left eye was diagnosed with orbital cellulitis and was treated by intravenous antibiotics, followed by improvement 8 days before. Funduscopy showed findings simulating central retinal vein occlusion with choroidal detachment in the inferior nasal quadrant. Optical coherent tomography（OCT）showed choroidal folds. Choroidal detachment disappeared 19 days after start of treatment. Choroidal folds persisted for 4 months after onset with visual acuity of 0.3 in the left eye.

Conclusion: This case suggests that orbital cellulitis may induce choroidal detachment by elevated intraorbital pressure and extension of inflammation through the site of perforation of vortex vein.